Zygomatic (Cheekbone) Fracture – A Comprehensive Patient Guide
Overview
The zygomatic bone, commonly called the cheekbone, forms the prominence of the mid‑face and contributes to the orbit (eye socket), the lateral wall of the maxillary sinus, and the facial contour. A **zygoma fracture** (or zygomatic complex fracture) occurs when a sufficient force breaks one or more parts of this bone.
Although any age can sustain a fracture, it most frequently affects:
- Young adult males (ages 15‑35) – they account for up to 45 % of facial fractures in many trauma registries.1
- Individuals involved in high‑impact activities such as motor‑vehicle collisions, assaults, sports collisions, and falls from height.
In the United States, facial fractures represent approximately 10 % of all emergency department (ED) visits for trauma, and the zygoma is the second‑most commonly broken facial bone after the mandibular (lower jaw) condyle.2
Symptoms
Symptoms can range from mild discomfort to severe facial deformity. Common manifestations include:
Local pain & tenderness
Sharp or throbbing pain over the cheekbone, especially when touching or moving the face.
Swelling & bruising
Rapid onset of facial swelling; bruising may appear black‑blue and spread to the eyelids (periorbital ecchymosis, “black eye”).
Visible deformity
A flattening or depression of the cheek, or a “step-off” where bone fragments are displaced.
Difficulty opening the mouth
Trismus (restricted jaw movement) can occur if the fracture involves the zygomatic arch, which serves as an attachment for the masseter muscle.
Numbness
Paresthesia in the cheek, upper lip, or lower eyelid due to irritation of the infra‑orbital nerve.
Eye problems
- Double vision (diplopia) when the fracture extends into the orbit.
- Dryness, tearing, or bulging of the eye (proptosis) if orbital walls are compromised.
Bleeding & nasal discharge
Blood from the nose or mouth may accompany the injury, especially when the fracture communicates with the sinus.
Hearing changes
Rarely, a fracture that involves the zygomatico‑temporal suture can cause a “clicking” sound or mild conductive hearing loss.
Causes and Risk Factors
Understanding the mechanism helps with prevention and anticipation of associated injuries.
Traumatic forces
- Motor‑vehicle collisions – The most prevalent cause; airbags and seat‑belt use have reduced severity but not incidence.
- Physical assaults – Direct punches or blows to the side of the face.
- Sports injuries – Contact sports (football, boxing, martial arts) and high‑speed activities (skiing, cycling) can deliver sufficient impact.
- Falls – Particularly from heights or onto a hard surface.
Risk factors
- Age < 30 years (higher activity levels and risk‑taking behavior).
- Male gender (≈ 3 : 1 male‑to‑female ratio).
- Alcohol or drug intoxication – Impairs judgment and coordination.
- Pre‑existing bone weakness (osteoporosis, chronic steroid use).
Diagnosis
Prompt and accurate diagnosis is essential to restore facial symmetry, prevent functional deficits, and avoid long‑term complications.
Clinical examination
- Inspection for swelling, bruising, asymmetry, and lacerations.
- Palpation of the zygomatic arch and infra‑orbital rim for step‑offs or crepitus.
- Neurologic assessment of infra‑orbital nerve sensation.
- Ophthalmologic screen: visual acuity, eye movement, and globe integrity.
Imaging studies
- Plain radiographs ( Waters or submentovertex views ) – Useful in low‑resource settings but limited by overlapping structures.
- CT scan (computed tomography) – Gold standard. Thin‑slice axial, coronal, and sagittal reconstructions delineate bone fragments, displacement, and associated sinus or orbital injury.3
- 3‑D reconstruction – Helps surgeons plan fixation and explain the injury to patients.
Additional assessments
- CT of the facial sinuses if there is concern for sinus involvement.
- Eye exam by an ophthalmologist if diplopia or globe injury is suspected.
Treatment Options
Treatment depends on fracture displacement, associated injuries, and patient’s functional needs.
Conservative (non‑surgical) management
- Indicated for non‑displaced or minimally displaced fractures without functional impairment.
- Analgesia: Acetaminophen or NSAIDs (ibuprofen 400‑600 mg every 6 h) for pain and inflammation.
- Cold compresses for the first 48 hours to reduce swelling.
- Soft diet for 1‑2 weeks if mouth opening is mildly limited.
- Close follow‑up (often 1 week) with repeat imaging if symptoms worsen.
Surgical intervention
Most displaced zygomatic complex fractures require open reduction and internal fixation (ORIF).
- Reduction – Realignment of bone fragments using manual pressure or specialized instruments.
- Fixation – Placement of titanium or bio‑resorbable plates and screws at strategic points (zygomaticofrontal suture, infra‑orbital rim, zygomatic arch). The goal is to restore facial height, projection, and orbital volume.
- Approaches – Common incisions include:
- Gillies temporal approach (for arch fractures).
- Keen (subciliary) or infra‑orbital approaches (for rim/orbital lesions).
- Intra‑oral (buccal) incision for medial‑maxillary involvement.
- Adjunctive procedures – May include orbital floor repair, sinus debridement, or nerve decompression.
- Post‑operative care –
- Antibiotics (e.g., amoxicillin‑clavulanate 875/125 mg BID for 5 days) to prevent sinus infection.
- Analgesics and a short course of steroids (e.g., dexamethasone 4 mg IV then taper) to reduce edema.
- Ice packs, head elevation, and avoidance of nose blowing for 2 weeks.
- Early jaw mobilization exercises after 48 h to prevent trismus.
Lifestyle adjustments during recovery
- Soft or pureed diet for 1–2 weeks.
- Avoid contact sports and heavy lifting for 6–8 weeks.
- Maintain oral hygiene with gentle rinses (chlorhexidine 0.12 %).
- Follow up with oral‑maxillofacial surgeon for suture removal (usually 5‑7 days) and repeat imaging (typically 4‑6 weeks).
Living with a Zygomatic Fracture
Recovery can be physically and emotionally challenging. Below are practical tips to aid daily life.
- Pain control – Stick to the prescribed schedule; don’t wait for pain to become severe.
- Swelling management – Apply a cold pack (15 min on, 15 min off) for the first 48 h; thereafter, a warm compress can improve circulation.
- Oral hygiene – Use a soft‑bristled toothbrush and avoid vigorous rinsing.
- Jaw exercises – Gentle opening and lateral movements 5–10 times, 3‑4 times a day after the first 48 h, to prevent stiffness.
- Nutrition – Focus on protein‑rich soft foods (yogurt, smoothies, scrambled eggs) to support bone healing.
- Eye care – If you experience dryness or mild diplopia, use lubricating eye drops and keep follow‑up appointments with ophthalmology.
- Psychological support – Facial injuries can affect self‑image; consider counseling or support groups if you feel anxious or depressed.
Prevention
While not all accidents are avoidable, many risk factors are modifiable.
- Wear protective gear – Sports helmets, face shields, and mouthguards reduce impact forces.
- Seat‑belt and airbag use – Consistently wearing a seat belt and ensuring airbags are functional cuts down on facial trauma in vehicle collisions.
- Avoid alcohol excess – Limit drinking when driving or participating in high‑risk activities.
- Maintain bone health – Adequate calcium (1,000 mg/day) and vitamin D (600–800 IU/day) intake, weight‑bearing exercise, and regular screening for osteoporosis.
- Environmental safety – Keep walkways clear, use non‑slip mats, and improve lighting to prevent falls at home.
Complications
If a zygomatic fracture is left untreated or inadequately managed, several problems may arise:
- Persistent facial asymmetry – Cosmetic deformity can be difficult to correct later.
- Malunion or non‑union – Misaligned bone heals in a wrong position, causing functional impairment.
- Infra‑orbital nerve injury – Chronic numbness or dysesthesia of the cheek, upper lip, and lower eyelid.
- Orbital complications – Enophthalmos (sunken eye), diplopia, or restrictive eye movement due to orbital floor involvement.
- Sinusitis or chronic maxillary sinus infection – Fracture communication with the sinus can lead to persistent infection.
- Temporomandibular joint (TMJ) dysfunction – Restricted jaw movement or pain from mal‑alignment.
- Psychosocial impact – Self‑esteem issues related to visible facial changes.
When to Seek Emergency Care
- Severe, uncontrolled bleeding from the nose, mouth, or eye.
- Sudden loss of vision, double vision that does not improve, or the eye appears sunken or bulging.
- Rapidly worsening swelling that makes breathing or swallowing difficult.
- Pronounced facial deformity or a palpable “step‑off” that is visibly displaced.
- Numbness spreading beyond the cheek (possible nerve damage).
- Severe headache accompanied by vomiting or loss of consciousness (possible intracranial injury).
Early evaluation by an oral‑maxillofacial surgeon, trauma surgeon, or emergency physician dramatically improves outcomes.
References:
1. American Association of Oral and Maxillofacial Surgeons. “Facial Fractures: Epidemiology.” 2022.
2. Centers for Disease Control and Prevention. “Traumatic Brain Injury and Facial Fractures.” 2021.
3. Mayo Clinic. “Zygomatic bone fracture (cheekbone fracture) – Diagnosis & treatment.” Updated 2023.
4. Cleveland Clinic. “Facial Trauma: What to Expect.” 2024.
5. World Health Organization. “Global Estimates on Injuries.” 2020.